{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:01:18Z","timestamp":1780732878798,"version":"3.54.1"},"reference-count":19,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T00:00:00Z","timestamp":1780358400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Oncol Pharm Pract"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Azacitidine-venetoclax has improved outcomes in older or intensive chemotherapy-ineligible acute myeloid leukemia (AML) patients. However, real-world experience and pharmacoeconomic evidence remain scarce in resource-limited settings, particularly in North Africa, where drug pricing and supportive care constraints significantly shape clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective single-center study was conducted at a tertiary military teaching hospital in Morocco (December 2019\u2013December 2025). Fifteen older or unfit AML patients receiving azacitidine-based regimens were included. Venetoclax was dose-reduced to 100\u2005mg\/day under concomitant voriconazole prophylaxis based on CYP3A4 inhibition principles. Kaplan-Meier survival analysis was performed. An exploratory pharmacoeconomic analysis was conducted from a hospital perspective, incorporating drug acquisition costs, infection-related hospitalization expenses, and quality-adjusted life-years (QALYs) derived from the literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Complete remission was achieved in 78% of first-line azacitidine-venetoclax recipients (n\u2009=\u20099) and 50% with azacitidine alone (n\u2009=\u20094). Infectious complications occurred in 73.3% of patients. Median overall survival was not reached; estimated survival probabilities were 76% at 12 months and 57% at 24 months. The incremental cost-effectiveness ratio (ICER) of azacitidine-venetoclax versus azacitidine alone was approximately 183,000 MAD per QALY gained (\u22482\u00d7 Morocco's GDP per capita) after incorporating infection-related costs. Venetoclax acquisition price was the primary cost-effectiveness driver on sensitivity analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Pharmacology-guided azacitidine-venetoclax regimens are clinically feasible in resource-limited settings, with encouraging survival outcomes. Infection management, antifungal prophylaxis strategies, and targeted drug pricing negotiations are key determinants of cost-effectiveness. Prospective multicenter studies are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10781552261456738","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T14:20:57Z","timestamp":1780410057000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pharmacology-Guided venetoclax dose reduction with azacitidine in older or unfit acute myeloid leukemia: A North African experience from a Moroccan single-center cohort and exploratory hospital cost-effectiveness analysis"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4527-2564","authenticated-orcid":false,"given":"Baztami","family":"Youssef","sequence":"first","affiliation":[{"name":"Cadi Ayyad University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilham","family":"Jebrane","sequence":"additional","affiliation":[{"name":"Cadi Ayyad University"},{"name":"Laboratory of Excellence for Innovations in Biotechnology, Pharmaceutical Bioengineering, and Artificial Intelligence, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Amine","family":"Aznag","sequence":"additional","affiliation":[{"name":"Ibn Sina Military Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rim","family":"Chakara","sequence":"additional","affiliation":[{"name":"Mohammed VI University Hospital Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siham","family":"Ahchouch","sequence":"additional","affiliation":[{"name":"Ibn Sina Military Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abderrahim","family":"Raissi","sequence":"additional","affiliation":[{"name":"Laboratory of Excellence for Innovations in Biotechnology, Pharmaceutical Bioengineering, and Artificial Intelligence, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakesh, Morocco"},{"name":"Ibn Sina Military Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2012971"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.2022016867"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2020.02.018"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2017.01.003"},{"key":"e_1_3_3_6_2","volume-title":"Venclexta (venetoclax) [prescribing information]","author":"AbbVie Inc","year":"2020","unstructured":"AbbVie Inc. Venclexta (venetoclax) [prescribing information]. North Chicago, IL: AbbVie Inc., 2020."},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2016-03-643544"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41375-022-01613-1"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2019.0028"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2004444"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.26039"},{"key":"e_1_3_3_12_2","volume-title":"R: A language and environment for statistical computing","author":"R Core Team","year":"2023","unstructured":"R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2023. https:\/\/www.R-project.org (2023, accessed 28 February 2026)."},{"key":"e_1_3_3_13_2","volume-title":"Methods for the Economic Evaluation of Health Care Programmes","author":"Drummond MF","year":"2015","unstructured":"Drummond MF, Sculpher MJ, Claxton K, et al. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press, 2015.","edition":"4"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-021-02204-0"},{"key":"e_1_3_3_15_2","unstructured":"Minist\u00e8re de la Sant\u00e9 et de la Protection Sociale Royaume du Maroc. Liste des m\u00e9dicaments remboursables et tarifs de r\u00e9f\u00e9rence. https:\/\/www.sante.gov.ma (2024 accessed 28 February 2026)."},{"key":"e_1_3_3_16_2","unstructured":"Agence Marocaine des M\u00e9dicaments et des Produits de Sant\u00e9 (AMMPS). Base de donn\u00e9es nationale des m\u00e9dicaments \u2014 Prix publics de vente. Disponible sur : https:\/\/ammps.sante.gov.ma\/basesdedonnes\/listes-medicaments [accessed: avril 2026]."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-8-50"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.00572"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2018-08-869008"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2016.02.017"}],"container-title":["Journal of Oncology Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552261456738","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10781552261456738","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10781552261456738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T07:49:27Z","timestamp":1780732167000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10781552261456738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,2]]},"references-count":19,"alternative-id":["10.1177\/10781552261456738"],"URL":"https:\/\/doi.org\/10.1177\/10781552261456738","relation":{},"ISSN":["1078-1552","1477-092X"],"issn-type":[{"value":"1078-1552","type":"print"},{"value":"1477-092X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,2]]},"article-number":"10781552261456738"}}